Eyelid Conditions Hordeolum Chalazion and Blepharitis

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Eyelid Conditions: Hordeolum, Chalazion and Blepharitis

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Eyelid Conditions: Hordeolum, Chalazion and Blepharitis Anne M. Friesen, BSc(Pharm), MSc Date of Revision: April 2013

Eye Anatomy

Eyelids and lashes protect the globe (eyeball) from foreign bodies and injuries and help maintain a wet corneal surface. The eyelid is a complex structure of skin, muscle and fibrous tissue. The skin of the eyelid is among the thinnest anywhere on the body, which allows for the mobility of the eyelids. Underneath the skin lies loose, areolar tissue that is capable of significant edema and swelling. The next layer is the orbicularis muscle, responsible for closing the eyelids and innervated by the seventh cranial nerve.1,2 Posteriorly in the eyelid is the tarsus, a dense fibrous connective tissue plate that supports the lid margins and forms the skeleton of the eyelid (Figure 1). Modified sebaceous glands, known as meibomian glands, are contained within the tarsal plates and secrete the lipid layer of the tear film. There are 20–30 glands in the upper lid and 10–20 in the lower lid.1,2,3 The glands of Zeis and Moll lie in the anterior section of the eyelid. Zeis's glands are modified sebaceous glands that are associated with the lash follicles. Moll's glands are modified sweat glands whose ducts open either into a lash follicle or directly onto the anterior lid margin between the lashes (Figure 2).4 Figure 1: Anatomy of the Eyelids and Anterior Eye

Figure 2: Cross-Section of Upper Eyelid

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Hordeolum

Pathophysiology

A hordeolum (stye) is an infection of the sebaceous glands of the eyelids. It is the most common eyelid infection in ophthalmology.3,5,6,7 When the glands of Zeis are involved, the infection is smaller and more superficial. In this type of infection, referred to as an external hordeolum, the lesion always points toward the skin. A larger swelling usually involves the meibomian glands and is called an internal hordeolum. This lesion can point either to the skin or to the conjunctival surface. It generally has a more prolonged course than an external hordeolum because it rarely drains spontaneously. Microbiologic cultures are seldom required for either type of hordeolum since the most common infecting organism is Staphylococcus aureus.

Goals of Therapy Resolve infection

Prevent recurrence

Prevent transmission to other eye or to household contacts

Patient Assessment

Patients with hordeolum present with unilateral, localized lid swelling, tenderness and erythema. The amount of discomfort increases with the degree of lid swelling. Hordeola are often associated with blepharitis and have a tendency to recur.2,5 An algorithm for the assessment of eye conditions is presented in Assessment of Patients with Eye Conditions.

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A common sense approach to avoid infecting the fellow eye or transmitting the infection to other persons in the household includes the following instructions for the patient: Avoid touching the eyes and wash the hands after any contact with the infected eye. Change compresses and towels after each use.

Take care not to allow the tip of eye drop bottles or ophthalmic ointments to touch the eye or eyelashes. Conscientious attention to treating symptoms of blepharitis may help to decrease the incidence of recurrent hordeola.

Nonpharmacologic Therapy

External hordeola usually drain spontaneously, but warm compresses applied for 10–15 minutes 3 or 4 times a day will hasten resolution, which usually occurs within 48 hours.2,3,8 Following warm compresses, gently massaging the eyelid toward the lid margin can also be helpful. Warm tap water is sufficient to use in compresses. There is a risk of burning the skin when using the microwave to heat warm compresses.9 A study showed that a hard-boiled egg, kept in the shell, retained heat longer than a warm compress.10 The authors suggest that a hard-boiled egg wrapped in a handkerchief or compress is a convenient and cost-effective way to apply heat to the eyelid. The same egg can be reboiled prior to each application. Caution patients against applying pressure on the warm compress or hard-boiled egg, as corneal deformation can occur resulting in blurred vision (usually transient following short-term use).11,12 If patients find it difficult to control the amount of pressure using the hard-boiled egg, they may try bending forward and holding the wrapped egg close to the eye without touching it.11 Refer patients to their physician if they have external hordeola that do not spontaneously drain within 48 hours. In these situations incision and drainage may be required.2,3,8 Acute internal hordeola, which generally resolve within 1–2 weeks, can be treated with warm compresses for 5–10 minutes several times a day. Refer patients to their physician if they have internal hordeola that do not resolve spontaneously in 1 week.13

Pharmacologic Therapy Nonprescription Therapy Self-medication with nonprescription ophthalmic antibacterials is not necessary and is not recommended.14

Prescription Therapy

If incision and drainage are required, the physician may prescribe an ophthalmic antibacterial ointment such as bacitracin or erythromycin, applied to the conjunctival sac several times a day, to help prevent further infection.2,3,8 If cellulitis develops or if the infection is severe, oral antibacterials such as erythromycin, cloxacillin or tetracycline may be prescribed.

Monitoring of Therapy

Table 1 provides a monitoring plan, which should be individualized.

Chalazion

Pathophysiology

A chalazion is an idiopathic, sterile, chronic inflammation of a meibomian gland. Blockage of the meibomian gland

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orifices results in stagnation of sebaceous secretions.2,8,16 A lesion develops over a period of weeks and is characterized by painless, localized swelling. Most chalazia point toward the conjunctival surface, causing conjunctival redness and swelling. Chalazia are more common in people with blepharitis, acne rosacea or seborrheic dermatitis. Other risk factors for chalazion include smoking, gastritis and irritable bowel syndrome.17 These patients are also at greater risk for the development of multiple or recurrent chalazia. Refer patients with recurrent or persistent chalazion to a physician to be evaluated for more serious conditions such as meibomian gland carcinoma.

Goals of Therapy Resolve lesion

Prevent recurrence

Patient Assessment

The initial symptoms of chalazion (mild inflammation and tenderness) may resemble hordeolum, but without the acute inflammatory signs.1,2,16 Chalazia may be distinguished from hordeola by the lack of pain.18 Table 1: Monitoring Therapy for Eyelid Conditions Eye Condition

Monitoring

Hordeolum

Patient: daily

Spontaneous drainage within 48 h.

Refer to a physician or eye care practitioner if drainage does not occur within 48 h, if pain worsens or if there are signs of infection.

Chalazion

Patient: daily

Improvement should begin within a few days. Complete resolution can take weeks to months.

If the lesion is large and/or painful or if spontaneous drainage does not occur, refer to a physician or eye care practitioner.

Control inflammation and discomfort.

Encourage compliance with lid hygiene regimen.a Ensure that patients cleanse only the margin of the eyelid and do not scratch the eyeball or conjunctiva.

Blepharitis

Pharmacist: after 48 h

Pharmacist: after 2–3 days

Patient: daily during exacerbation. Less often when controlled

Pharmacist: each pharmacy visit in chronic disease. Within 1 wk if patient requires anti-infective therapy

a

3,5,8,14,15

Goals/End Point of Therapy

Reduce the risk of severe, long-term complications.

Actions

For patients with blepharitis, encourage regular lid hygienea to prevent chalazion recurrence.

Refer to a physician or eye care practitioner if new onset of blepharitis is suspected.

Refer exacerbations to a physician or eye care practitioner to assess need for anti-infective or other therapy.

See Blepharitis, Nonpharmacologic Therapy.

Large chalazia may press on the eyeball and cause astigmatism or visual distortion. An algorithm for the assessment of eye conditions is presented in Assessment of Patients with Eye Conditions.

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Prevention

Encourage patients who have recurrent chalazia associated with blepharitis to maintain good lid hygiene (see Blepharitis, Nonpharmacologic Therapy). Advise patients with dermatologic conditions such as acne rosacea and seborrheic dermatitis to adhere to treatment of these conditions. Encourage and support smoking cessation.

Nonpharmacologic Therapy Initial treatment for chalazion is similar to that for hordeolum, especially for small lesions.16,19,20 Warm compresses, applied several times a day, are used to soften sebaceous secretions that may be blocking meibomian gland orifices. Approximately 25–50% of lesions resolve with this treatment. Following warm compresses, gently massaging the eyelid toward the lid margin may also be helpful. Refer patients to a physician or eye care practitioner if the lesion does not begin to resolve within a few days of initiating warm compress treatment. Immediate referral is required for patients experiencing eye pain or impaired vision.

Pharmacologic Therapy Nonprescription Therapy

Self-medication with nonprescription ophthalmic antibacterials is not necessary and is not recommended for chalazia.1,16,18

Prescription Therapy Larger chalazia may require surgical excision, intralesional steroid injections, or both.16,19,20 These procedures should be performed by an ophthalmologist. When excision is required, the ophthalmologist makes a vertical incision on the conjunctival surface, followed by careful curettement of the gelatinous material. Topical antibacterials or corticosteroid drops may be prescribed after surgery to prevent infection and decrease inflammation. The presence of cellulitis is an indication for the use of systemic antibacterials.

Monitoring of Therapy

Table 1 provides a monitoring plan, which should be individualized.

Blepharitis

Pathophysiology Blepharitis is a chronic condition, with periods of exacerbation, that usually affects the eyelids bilaterally.6,7 Although the different types can be defined as anterior and posterior, blepharitis often occurs as a mixed condition in patients, making it difficult to accurately diagnose and treat. It is often associated with chronic dermatologic conditions such as acne rosacea and seborrheic dermatitis,21 as well as pterygia, ulcerative colitis, irritable bowel syndrome, anxiety and gastritis.22 These conditions must also be addressed for optimal control of blepharitis. Long-term complications of this chronic disorder include physical damage to the eyelids as well as damage to the cornea.6,7 Inflammation of the cornea can result in scarring, loss of surface smoothness and loss of visual acuity. If the inflammation is severe, corneal perforation may occur.

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Anterior Blepharitis Staphylococcal blepharitis is usually caused by S. aureus or S. epidermidis.6,7 Patients present with inflammation and erythema along the anterior margin of the eyelid. The lid margins are scaly, with crusts and tiny ulcerations around the lashes. In chronic inflammatory staphylococcal blepharitis, loss of eyelashes (madarosis) may occur. Complications of staphylococcal blepharitis include recurrent hordeola or chalazia, epithelial keratitis of the lower third of the cornea and marginal corneal infiltrates. Seborrheic blepharitis (nonulcerative) presents with less inflammation and redness along the anterior border of the eyelid and the scales are more oily or greasy than in staphylococcal blepharitis.6,7 Seborrheic blepharitis is often associated with seborrheic dermatitis affecting other parts of the body. Although 2 types of anterior blepharitis have been identified, it is more common for patients to present with a mix of staphylococcal and seborrheic types.6,7 Patients with either form of anterior blepharitis are also predisposed to developing conjunctivitis.

Posterior Blepharitis

Meibomian gland dysfunction can lead to inflammation of the posterior aspect of the eyelid (closer to the eyeball).2,6,7 This is a bilateral, chronic condition that sometimes coexists with anterior blepharitis. Meibomian seborrhea is characterized by excessive glandular secretions.2,6,7 Symptoms can include photophobia, burning sensation, an excessively oily or foamy tear film and froth on the lid margin. Although they may be difficult to detect, small oil globules may be sitting at the meibomian gland orifices on the lid margin. There are usually few signs of inflammation. Meibomianitis is characterized by inflammation and obstruction of the meibomian glands.2,6,7 Signs include diffuse or localized inflammation of the posterior lid margin. In chronic cases the meibomian gland orifices become obstructed and the posterior lid margin may become thick, rounded and notched. When pressure is applied over the glands, a soft cheesy substance is expressed. In very severe cases the glands are completely blocked so no secretions can be expressed.

Goals of Therapy

Reduce inflammation and discomfort associated with blepharitis Reduce the risk of recurrence of severe symptoms

Reduce the risk of complications such as conjunctivitis and keratitis

Patient Assessment

Generally, symptoms of blepharitis include irritation, burning and itching of the lid margins. There may also be a foreign-body sensation in the eye.7,15,23 Patients may complain of a sandy or gritty sensation in the eyes that is worse upon awakening since, during sleep, the inflamed eyelids lie against the cornea, tear secretion decreases, and inflammatory mediators have several hours to act on the surface of the eye. See also Pathophysiology, anterior and posterior blepharitis, above. An algorithm for the assessment of eye conditions is presented in Assessment of Patients with Eye Conditions.

Prevention

Blepharitis is almost always a chronic condition that frustrates patients, physicians and eye care practitioners. Inadequate instruction and noncompliance with lid hygiene are the most common reasons for treatment failure.8

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Encourage patients to maintain a long-term lid hygiene program as this helps prevent exacerbations and long-term complications. Treatment of dermatologic disorders elsewhere in the body, such as seborrheic dermatitis, is important in achieving long-term control of blepharitis.5,14,15

Nonpharmacologic Therapy

For product selection, consult Products for Minor Ailments. Ophthalmic Products: Cleansers and Washers. Treatment for all types of blepharitis consists of regular and long-term eyelid margin hygiene:6,15,23,24 1. Warm compresses, applied to closed eyelids for 5–10 minutes, help to melt solidified material in the glands.

2. Gentle cleansing of the lid margin follows. Instruct the patient to gently scrub only the lid margin, not the conjunctiva or outer lid area, using warm water with a facecloth, a commercial eyelid scrub (e.g., Blephagel, Lid-Care), or a cotton swab dipped in a solution of baby shampoo diluted with warm water.

3. Mechanical expression, performed by an ophthalmologist, may be necessary to decrease the amount of irritating lipids within the glands. The patient may be instructed to perform firm massage of the lid margins, after applying warm compresses, to enhance secretion from the meibomian glands. One hand holds the eyelid taut at the outer corner, while the index finger of the other hand presses along the lid from the inner corner out. Alternatively the patient may simply apply direct pressure to the lid if that is more comfortable. Lid hygiene may be required once or twice daily, immediately after initial diagnosis or during periods of exacerbation, but may be reduced to twice a week once control has been achieved.6,15,23,24 This decision should be made by the treating physician or eye care practitioner. Very few patients will be able to completely discontinue a lid hygiene regimen.

Pharmacologic Therapy Nonprescription Therapy

For product selection, consult Products for Minor Ailments. Ophthalmic Products: Anti-infectives. Advise patients to use topical nonprescription antibacterials for blepharitis only on the advice of a physician or eye care practitioner. Omega-3 fatty acids (e.g., flaxseed oil supplements), which have anti-inflammatory properties and may enhance lubrication, may be useful in patients with tear deficiencies.21

Prescription Therapy

Pharmacologic treatment of anterior blepharitis may include topical antistaphylococcal antibiotics, used after eyelid cleansing.15,23 Antibacterial ointments, applied on the lid margins, are preferred to drops because of increased contact time between the drug and tissues. Ointments that cover gram-positive organisms, such as bacitracin and erythromycin, are applied 1–4 times per day for 1–2 weeks. If effective, treatment can be reduced to once daily at bedtime for a further 4–8 weeks. Continue treatment for a month after all signs of inflammation have subsided. Short-term treatment with topical corticosteroids or corticosteroid/antibacterial combinations may be necessary during exacerbations, or for severe inflammation and complications.15,23 In posterior blepharitis, patients may require systemic antibacterial therapy for several weeks or even months, in addition to lid hygiene.15,23 Tetracycline, doxycycline or minocycline is usually the drug of choice. Erythromycin is an alternative when tetracyclines are contraindicated. However, its efficacy has not been as well established as that of the tetracyclines.

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Table 1 provides a monitoring plan, which should be individualized.

Resource Tips

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Mayo Clinic. Blepharitis. Available from: www.mayoclinic.com/health/blepharitis/DS00633. MedicineNet. Sty (stye, hordeolum). Available from: www.medicinenet.com/sty/article.htm. Registration required. U.S. National Library of Medicine. MedlinePlus. Blepharitis. Available from: www.nlm.nih.gov/medlineplus/ency/article /001619.htm.

Suggested Readings

Gilchrist H, Lee G. Management of chalazia in general practice. Aust Fam Physician 2009;38:311-4. Jackson WB. Blepharitis: current strategies for diagnosis and management. Can J Ophthalmol 2008;43:170-9. Merck Manual: for health care professionals. Chalazion and hordeolum. Available from: www.merck.com/mmpe/sec09 /ch100/ch100e.html. Sullivan JH, Shetlar DJ, Whitcher JP. Lids, lacrimal apparatus, & tears. In: Riordan-Eva P, Whitcher J, eds. Vaughan & Asbury's general ophthalmology. 17th ed. New York: Lange Medical Books/McGraw-Hill Medical; 2008.

References 1. Rubin S, Hallagan L. Lids, lacrimals, and lashes. Emerg Med Clin North Am 1995;13:631-48. 2. Sullivan JH, Shetlar DJ, Whitcher JP. Lids, lacrimal apparatus, & tears. In: Riordan-Eva P, Whitcher J, eds. Vaughan & Asbury's general ophthalmology. 17th ed. New York: Lange Medical Books/McGraw-Hill Medical; 2008. 3. Lederman C, Miller M. Hordeola and chalazia. Pediatr Rev 1999;20:283-4. 4. Kanski JJ. Clinical ophthalmology: a systematic approach. 4th ed. Oxford: Butterworth-Heinemann; 1999. 5. Shields SR. Managing eye disease in primary care. Part 2. How to recognize and treat common eye problems. Postgrad Med 2000;108:83-6, 91-6. 6. Raskin EM, Speaker MG, Laibson PR. Blepharitis. Infect Dis Clin North Am 1992;6:777-87. 7. Thielen TL, Castle SS, Terry JE. Anterior ocular infections: an overview of pathophysiology and treatment. Ann Pharmacother 2000;34:235-46. 8. Mueller JB, McStay CM. Ocular infection and inflammation. Emerg Med Clin North Am 2008;26:57-72. 9. Jones YJ, Georgesuc D, McCann JD et al. Microwave warm compress burns. Ophthal Plast Reconstr Surg 2010;26:219. 10. Freedman HL, Preston KL. Heat retention in varieties of warm compresses: a comparison between warm soaks, hard-boiled eggs and the re-heater. Ophthalmic Surg 1989;20:846-8. 11. McMonnies CW, Korb DR, Blackie CA. The role of heat in rubbing and massage-related corneal deformation. Cont Lens Anterior Eye 2012;35:148-54. 12. Lam AK, Lam CH. Effect of warm compress therapy from hard-boiled eggs on corneal shape. Cornea 2007;26:163-7. 13. Lindsley K, Nichols JJ, Dickersin K. Interventions for acute internal hordeolum. Cochrane Database Syst Rev 2010;(9):CD007742. 14. Baum J. Infections of the eye. Clin Infect Dis 1995;21:479-86. 15. Jackson WB. Blepharitis: current strategies for diagnosis and management. Can J Ophthalmol 2008;43:170-9. 16. Gilchrist H, Lee G. Management of chalazia in general practice. Aust Fam Physician 2009;38:311-4. 17. Nemet AY, Vinker S, Kaiserman I. Associated morbidity of chalazion. Cornea 2011;30:1376-81.

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18. Arbabi EM, Kelly RJ, Carrim ZI. Chalazion. BMJ 2012;341:c4044. 19. Cottrell DG, Bosanquet RC, Fawcett IM. Chalazions: the frequency of spontaneous resolution. Br Med J (Clin Res Ed) 1983;287:1595. 20. Smythe D, Hurwitz JJ, Tayfour F. The management of chalazion: a survey of Ontario ophthalmologists. Can J Ophthalmol 1990;25:252-5. 21. Bernardes TF, Bonfioli AA. Blepharitis. Semin Ophthalmol 2010;25:79-83. 22. Nemet AY, Vinker S, Kaiserman I. Associated morbidity of blepharitis. Ophthalmology 2011;118:1062-8. 23. eMedicine from WebMD. Lowery RS. Blepharitis, adult. Available from: emedicine.medscape.com. Accessed July 12, 2009. Registration required. 24. Morrow GL, Abbott RL. Conjunctivitis. Am Fam Physician 1998;57:735-46.

Safe Use of Eye Products — What You Need to Know General information about eye products (drops, ointments): Eye products are only for external use. Follow the directions carefully.

Keep eye products out of the reach of children.

Never share your eye products with another person. Close containers tightly after use.

Store eye products in a cool, dark place. Some products have to be stored in the refrigerator. Ask your pharmacist how to store the products. Discard the product:

if it changes colour or appearance

if it was opened more than 1 month ago

immediately after use if it is a single-dose package without preservatives. Do not use the leftover product later.

Hints for using eye products:

If you have difficulty using your eye product, ask a family member or friend to help you. You can also ask your pharmacist about devices that might help. Wash hands well with soap and water before and after using the product.

Do not allow the tip of the container to touch the eyes, eyelids, eyelashes, fingers or counter surface. Contact with any surface can contaminate the product. Be sure to put the cap of the container on a clean tissue when you use the product to avoid contamination of the cap. Replace the cap as soon as possible.

Some products may blur your vision for a short time. Do not drive or perform hazardous tasks until you can see clearly again.

How to deal with problems:

Discontinue using the medication and see your eye care professional if: you have pain in your eye

your eyes become sensitive to light your vision changes in any way

the eye irritation and redness continues

the condition lasts longer than 48 hours after you stop using the medication

the condition does not improve after 48 hours of treatment with anti-infectives or 72 hours of treatment with

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other agents

the condition gets worse

Proper Use of Eye Drops — What You Need to Know Hints to help you use eye drops safely:

Wash hands well with soap and warm water before using eye drops.

Remove the bottle cap carefully. Lay the cap on its side on a clean, dry tissue. Do not touch the rim of the bottle or the inside of the cap. You may contaminate them. If the medication is a suspension, shake the bottle before using it. Ask your pharmacist if you’re not sure. Tilt your head back or lie down.

Keep both eyes open. Gently pull the lower eyelid of the affected eye down to form a pouch.

Hold the bottle almost horizontally. Bring it up to your eye from the side. This reduces the risk of accidentally hitting your eye with the tip of the bottle.

Hold the tip about 2.5 cm (1 inch) away from the eyelid. Do not touch the lid or lashes with the tip of the bottle. Look upwards by moving your eyes only (keep your head tilted back). Looking up moves the centre of the eyeball away from where the drop is going. It will keep your eye from blinking hard when the drop goes in.

Put one drop into the pouch of the lower eyelid. Continue to hold your head back so the drop can fall as deeply as possible into the pouch. Look down for several seconds and then slowly release the lower lid. Looking down allows the medication to reach the centre of the eye. This is especially important for infections of the cornea.

Gently close the eyes. Do not squeeze the eyes shut—you may force the medication out. Keep eyes closed for at least 30 seconds—longer is better (up to 5 minutes). This will keep the medication in contact with the eye for as long as possible. You can press gently on the side of the bridge of the nose with your thumb and index finger to help keep the medication from going down the tear duct. If you have recently had eye surgery or have had punctal plugs inserted, ask your eye doctor whether it is safe to apply pressure to the bridge of your nose.

Before opening the affected eye, use a clean tissue to blot away excess medication. Do not rub the eye. Try not to blink. Do not rinse the tip of the eye drop bottle. Replace the bottle cap. Wash hands well with soap and warm water.

If more than one drop of the same medication is prescribed, wait 3–5 minutes between drops. This ensures the first drop is not flushed away and the second drop is not diluted by the first. If you are using more than 1 medication, wait 5–10 minutes before applying another medication.

If you have problems with balance or dizziness, lie down or sit down in a very stable position before using your drops. This will reduce your risk of falling. If you have tremors (shaking) or arthritis, ask your pharmacist or eye care professional about devices to help you use eye drops.

Eye drop bottles usually contain a preservative to prevent the medication from being contaminated. However, the bottle can become contaminated over time, especially if the bottle tip has come into contact with the eye or the eyelashes. It's a good idea to throw out any bottles that have been open for a month or more. Figure 3: Eye Drop Instillation

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Proper Use of Eye Ointments — What You Need to Know General instructions:

Wash hands well with soap and water before using an eye ointment.

If you have to use both an ointment and eye drop, use the eye drop first. Wait at least 5 minutes before using the ointment. If you have to use different types of ointments, wait at least 10 minutes before using the second one.

If you have to apply the ointment to the outer eyelids, use a sterile cotton-tipped applicator to apply the ointment.

How to apply eye ointment:

Hold the tube in your hand for a few minutes to warm the ointment and help it flow better. Remove the container cap. Lay it on its side on a clean, dry tissue. When you open the tube for the first time, squeeze out and throw away the first 0.25 cm (0.1 inch) of ointment as it may be too dry. Tilt your head back or lie down.

Keep your eyes open. Gently pull down on the lower eyelid to form a pouch.

Hold the tube almost horizontally. Bring it up to your eye from the side. This reduces the risk of accidentally hitting your eye with the tip of the tube.

Hold the tip about 2.5 cm (1 inch) away from the eyelid. Do not touch the lids or lashes with the tip of the tube.

Look upwards by moving your eyes only (keep your head tilted back). Looking up moves the centre of the eyeball away from where the ointment is going. It will keep your eye from blinking hard when the ointment goes in. Place 0.6–1.25 cm (1/4–1/2 inch) of ointment into the pouch of the lower eyelid. It is not necessary to place the ointment along the entire length of the pouch. Gently close the eye for 1–2 minutes and roll the eyeball in all directions. Replace the container cap.

Use a clean tissue to remove excess ointment from around the eyelid. Wash hands thoroughly.

Eye ointments usually contain a preservative to prevent contamination of the medication. However, they can become contaminated over time, especially if the tip has come into contact with the eye or the eyelashes. Throw out any tubes that have been open for a month or more.

Remember: Your vision may be blurred for a few minutes after you put the ointment in. Do not drive or operate machinery until you can see clearly. Figure 4: Eye Ointment Instillation

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Eye Drops for Children — What You Need to Know

Before you put drops in a child's eyes, wash your hands well with soap and water. It is also important to get the child in a good position.

Positioning:

Have the child lie down and close the eyes.

For infants and small children who may not cooperate, try this alternative method:

sit on the floor and have the child sit on your lap, facing you. Their legs should be open over yours. Your legs may be spread slightly. while supporting the back and head, gently lower the child backwards until the child is lying along your legs.

Holding the child's head:

You may use several methods to hold the child's head, depending on how much control you want. You may need another person to help.

With the child lying down, hold the head with one hand. Use your other hand to put drops in the eye on the side you are holding. If the child resists, you may gently clamp the head between your legs and wedge the child’s feet against your body under your arms.

Putting the drops into the eyes (instillation):

Wash your hands well with soap and water before you begin.

If the medication is a suspension, shake the bottle before using it. Ask the pharmacist if you are not sure.

Hold the container horizontally as you bring it up to the eye. Rest your hand on the child’s cheek to prevent injury to the eye if the child moves suddenly.

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Open eye method:

If the child is able to cooperate you can use this method:

Tilt the child’s head back or have the child lie down.

Gently pull the lower eyelid of the affected eye down to form a pouch.

Hold the tip of the bottle about 2.5 cm (1 inch) away from the eyelid. Do not touch the lid or the lashes with the tip of the bottle. Have the child look upward, moving only the eyes. This will help to keep the child from blinking when the drop goes in.

Put the recommended dose into the pouch of the lower eyelid. Keep the child's head back so the medicine can get deeply into the pouch.

Have the child look down, moving only the eyes. Looking down allows the medication to reach the centre of the eye. Allow the child to close the eyes gently for about 30 seconds. Tell the child not to squeeze the eyes shut tightly. Squeezing may force the medication out. Before the child opens the eye, use a clean tissue to blot any excess medication. Do not allow the child to rub the eye. Ask the child to try not to blink.

Alternate methods:

These methods work better for younger children or children that are resisting the medication. They are also useful for adults with a strong blink reflex.

1. Place the drop on the eyelid in the inner corner of the eye, then have the child open the eye so the drop falls in by gravity. 2. Pull the lower lid down and instil the drop through the lashes. Avoid touching the bottle to the lashes.

Remember: If the medication is important, it is better to get some drops or ointment on the lids and lashes (with the eye closed) where it could seep onto the surface of the eye, than not to use the drops or ointment at all.

Infections of the Eyes or Eyelids — What You Need to Know When should you see your doctor? See your eye care professional if:

you have pain or severe redness in your eyes

your vision is altered—you can't see as well as usual you have had this problem before

you have a disease (such as diabetes) along with your eye problem

you have used a nonprescription treatment for 48 hours or more but the condition has not improved the condition gets worse with treatment

without treatment, the condition has lasted longer than 48 hours

Hints to help you manage an infection of the eye or eyelids:

Use separate facecloths, towels, pillows and sheets from other family members to prevent the infection from spreading. Use a clean facecloth and towel each time you clean your eye. Wash your hands with soap and water before and after touching your eyes.

It is important to clean the eye area before applying any medication. This is particularly true when there is a sticky discharge or an eyelid infection. Clean the lids well with soap and water.

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Eyelid Conditions: Hordeolum, Chalazion and Blepharitis

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https://www.e-therapeutics.ca/print/new/documents/MA_CHAPTER/en/...

If you need to use a device to put in your eye drops, wash it with soap and warm water after each use. Do not use an eye patch unless your eye care professional recommends it.

Avoid using mascara and other cosmetics while your eye is infected. Cosmetics may need to be discarded as they may contain bacteria that can reinfect your eye later on. CPhA assumes no responsibility for or liability in connection with the use of this information. For clinical use only and not intended for for use by patients. Once printed there is no quarantee the information is up-to-date. [Printed on: 03-03-2016 06:43 AM] RxTx, Compendium of Therapeutics for Minor Ailments © Canadian Pharmacists Association, 2016. All rights reserved

03-Mar-16 6:43 AM